An interview with our new CNO and CMO

CNO Sherry Kwater and CMO Carol Freer

Chief Nursing Officer Sherry Kwater and Chief Medical Officer Dr. Carol Freer

Earlier this year, Carol Freer, M.D., M.S., F.A.C.P., C.P.E., ’91, was appointed chief medical officer (CMO) for Penn State Hershey Medical Center. She had served as the interim CMO since July 2011. Freer joined Penn State Hershey in 2008 as associate professor of medicine and director of hospitalist outreach. In 2009, she became vice chair for clinical affairs in the Department of Medicine.

At the end of 2011, Sherry Kwater, M.S.M., B.S.N., R.N.,  was appointed chief nursing officer (CNO) for the Medical Center after serving as interim CNO since last May. She joined the Medical Center in August 2010 and brings more than twenty-five years of health care executive leadership to the role.

Freer and Kwater recently answered some questions about their new leadership roles, their vision for helping shape the Medical Center’s continuing growth, and what it’s like to work together toward improving patient quality and care.

Describe your vision for your new position?

Freer: I think a CMO walks a fine line. It’s one of the only senior management positions where you are both a physician and an administrator. I look at my role as being a strong physician advocate but also being responsible for the organization functioning in a safe and fiscally responsible manner. The objectives of these two roles [CMO and physician] aren’t always the same. It’s a complicated position but also a highly satisfactory one.

Kwater: As CNO, I’m responsible for the nursing practice activity related to patient care across the Penn State Hershey Medical Center system, whether it’s inpatient or outpatient. I’m absolutely passionate about patient care so I’m happy to do whatever I can to help nurses give the best care. In that regard, I want people to feel comfortable in coming to me if they have a question or concern, because if something is not working, I want to understand the issues and resolve what is not working.

We do not work for the process, it should work for us. I also believe that decision making needs to occur as close to the patient as possible. As long as everyone is clear on the vision and the guidelines for making those decisions, we will be a stronger organization. 

What is your leadership vision for your area? What are your short- and long-term goals?

Freer: One of my main areas of focus is fostering an environment of strong communication. As a leader in this institution, I want to champion that. It represents the ultimate goal of quality. By improving how we communicate with each other and with patients, we can improve patient satisfaction and avoid safety issues. One of my short-term goals is to get a better handle on patient logistics. We must become more efficient in how we move patients through our system. We are tackling this by collaborating with the Center for Integrated Healthcare Delivery Systems (CIHDS), reviewing our Emergency Department processes, and by looking at the role of the care coordinator. As we move forward and embrace patient-centered medical homes, accountable care organizations, and a bundling payment system, the need for efficient and safe transitions of care becomes exceedingly important. It all falls under the umbrella of being an integrated healthcare system, which we are.

Kwater: I have four priorities. First is to maintain and advance our Magnet designation because it affirms we’re performing at a level that’s above average. My second priority is addressing capacity and throughput efficiencies. We want to improve our intake, throughput, and discharge of patients in a quality way. This is a major focus for me throughout the Medical Center. The third is to work on the “Healthy Work Environment,” which gives us an opportunity to dialog with nurses about how we can improve our work environment together. The fourth is most important and is my baseline for everything. It’s my focus on quality and safety, and making sure that we’re delivering the best and safest service and care to our patients and putting processes in place that protect them from harm. 

What changes have been made over the last year with respect to quality and patient safety initiatives?

: We are raising people’s awareness of our organizational quality goals at the hospital related to mortality, infection rates, readmission rates, patient satisfaction, and so on. Additionally, the Centers for Medicare & Medicaid Services (CMS) have put into place the value-based purchasing program, where there are financial incentives–or potential penalties–tied to quality indicators. We’re beginning to make sure that everyone in our organization understands how these quality measures tie to our financial success. 

Also, we’re in process of implementing Red Rules, which focuses on processes that are so important that policy and procedures must be implemented 100 percent of the time without exception. One example would be a thorough time-out during surgery, which has been proven to reduce errors. The goal of the Red Rule is to shift the culture to give every member of the team the authority and responsibility to speak up if a patient is potentially at risk of harm.

Freer: Additionally, we have been able to improve quality by being more accessible to our referring partners using a Flex unit. This unit allows us to accommodate more transfer patients from the many local hospitals with which we work. This new unit serves as a buffer, enabling us to transition patients who may no longer need ICU-level care, for instance, to an appropriate level of care until a bed on another unit opens up, and open up those other beds for new patients – especially those who require our specialized services or higher acuity care. 

There is a new Center for Quality Initiatives in development. What does this mean for the organization?

: We have put a greater emphasis on quality throughout the organization. For example, we now have physician quality leaders who are taking quality initiatives back to their individual departments. 

Furthermore, we have a system in place to monitor quality among our physicians. Every two years, physicians are re-appointed to the medical staff at which time we will review their cases to determine if there are any areas where we can offer praise or emphasize improvement. Whenever there is a complication, or adverse event, individuals from Risk and Quality collaborate and analyze what changes may be necessary to prevent similar complications moving forward. Our standard of care involves this continuum of analysis to ensure we have the best, most evidence-based and safest environment for patients. 

For years, hospitals emphasized the financial aspect of care. Now quality has taken its rightful place next to finance. We are embracing this focus on quality. Without good quality, you cannot have good finances. These initiatives, and the many people driving them forward, can give our patients the best and safest care. 

Kwater: Penn State Hershey stands for quality and because we’re a teaching institution, we have many nursing students, medical students, and residents learning how to conduct themselves in the health care environment. It gives us an opportunity to focus on doing the right thing at the right time, in the right way the first time. Whether you work in the finance department or the clinical areas, the focus on quality and safety should be on everyone’s agenda. 

You both started in your new roles about the same time. What is it like working together?

: It’s been a great opportunity to collaborate with Dr. Freer because she brings a new perspective around her role. We have similar objectives and desires for the organization, so it’s great to know you have someone who you can partner with to move the organization in the right direction. 

Freer: We were recently talking, and we both said, “Boy, I’m glad you’re here.” We’re at a very interesting time in medicine where we must have our finger on the pulse. We can’t afford not to if we want to move forward. Together, we have these common goals and we have latitude to bring new initiatives to the table to help accomplish them. 

What personal experience has inspired you professionally?

Kwater: Before I decided to go into nursing, my husband and I had a child who was terminally ill. There was a nurse who worked with us at the hospital. She helped us understand what our options were and how to make our daughter’s end-of-life experience a meaningful family event. Although she passed away in the hospital, it didn’t feel that way. This nurse was so passionate about making sure we understood what our daughter’s passing would feel like, sound like, and look like. She was so good at describing every emotion, that by the time I experienced each one, I was able to recognize them as being normal. I’ve had dozens of mentors over the years, but she was wonderful and probably influenced me the most. She made me want to be a nurse and have that kind of effect on people’s lives.

Freer: The summer before I came here, I had some personal difficulties including a recent battle with breast cancer. It was quite devastating. A friend of mine who had invasive breast cancer asked me if I would join her in climbing Mt. Kilimanjaro in Tanzania. I didn’t think I could do that, but she said to me, “of course you can.” Together with my friend, my daughter, and three other people, we did it. 

When I got to the top of that mountain, all those things that were holding me back were gone, and I was able to move forward with my life. That’s why I ended up accepting this job. I was in a situation where I wasn’t particularly happy, but I was comfortable. I knew making this change would make me happy, but it wouldn’t be comfortable. That experience was exceedingly important in proving to me that I could free myself of adversity by conquering things that are seemingly impossible if I put my mind to it. Additionally, my daughter and I raised $35,000 for cancer research, some of which was given to us by people here at the Medical Center.

– By Dawn Costantini


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